Early Signs of Cerebral Palsy or Developmental Delay Part 1: Recommendations from a Pediatric Physical Therapist in Reno-Sparks

“Is this normal?” is a thought that every parent has had regarding development especially for new parents. As parents, we want what is best for our children and it’s hard when things don’t go as expected. My son was born premature at 33+0 so I was obsessing over his development and questioning every tiny movement, sound, or behavior even as a pediatric physical therapist.

I want to start off by saying that your child is beautiful, loved, and perfect regardless of whether or not they are developing typically. At Ready to Roll Physical Therapy, I believe in the value and dignity of all persons and truly enjoy working with the medically complex population. However, I also understand how scary and uncertain it can be when your child is not developing as expected. You can love your child exactly as they are AND also want to provide them with the best possible care to optimize their abilities while feeling grief or fear during the journey. 

If you’ve stumbled upon this page while as a worried new parent, you might be concerned about something your child is doing. Your first step should be to discuss your concerns with your child’s pediatrician. Dr. Google can be a blessing or a curse, sometimes providing comfort and other times spiraling us into unnecessary anxiety. So I’m also assuming that at this point, you’ve googled your specific concern. And I’m assuming that depending on the behavior or “symptom” you’ve googled, the answer wasn’t as clear as you had hoped. The joys of parenting. 

One of the “joys” of physical therapy and of child development is that the answer is often “it depends.” Some concerns or behaviors we can pretty easily say “normal” or “not normal” and other times we need to perform a comprehensive evaluation to determine the best course of action. Please don’t be afraid to reach out to myself or another pediatric therapist (PT, OT, or Speech) and ask for an evaluation. We are always happy to help and can sometimes even provide answers with a short consultation. Usually, your child is developing typically and we can provide comfort. However, this blog is written for the person experiencing “Mom (or Dad) Gut.”

I’m trying to write for the parent who feels deep down that “something is wrong”. If that’s you, please keep reading. Perhaps you’ve brought your concerns up to another provider who is not concerned or is taking a wait-and-see approach. Or maybe, your friends and family are telling you not to worry but that fear just doesn’t seem to go away. I hope this blog piece will provide you some clarity or even just the confidence to demand a more thorough assessment for your child. Trusting your instincts is the best thing you can do for your child because this blog is, well, just a blog. This isn’t medical advice or a formal assessment. This is validation that you know what’s best for your child and have the right to advocate for him or her in medical environments. 

So when should you be really concerned? There are a few “red flags” that should warrant a discussion with a pediatrician and/or pediatric physical therapist. Many times developmental delays become more apparent over time, but there are some symptoms that can present quite early. To be clear, the presence of one (or even all) of these symptoms/signs does not automatically mean there is something going on. It does mean, you should speak to a health care professional and possibly request specific developmental testing. I will speak on that in Part 2. Red flags by age are listed below. These lists are not necessarily all inclusive and are focused on neurological concerns (epilepsy, cerebral palsy, severe genetic disorders, etc) rather than neurodevelopmental concerns (ADHD, autism, behavioral issues, etc). 

If your child was born prematurely, please remember to account for their adjusted age. Subtract the prematurity from their actual age. For example, if they are currently 7 months old but were born 3 months early they would be considered 4 months old with respect to these lists. 

0-3 months 

• a newborn that is too floppy or too stiff 

• a newborn that is VERY difficult to arouse 

• trouble feeding/latching/gaining weight

• no progression over the 3 month period with head/neck control or eye movements 

• not startling to loud sounds 

• movements are very patterned and rhythmic, should be fidgety and unpredictable in the first 1-2 months 

• one side of the body appears floppy, stiff, or does not move as well as the other side 

3-6 months old

• everything listed above

• fist(s) remain clenched

• general floppiness or stiffness 

• not tracking items with their eyes

• unable to tolerate tummy time and/or lift their head and neck off of the ground consistently 

• not reaching with one or both hands 

• extremely difficult to soothe

• is not smiling or interacting with environment (interest in toys, people, ceiling fans, etc) 

• sudden jerking, spasms, or crunching movements that last 1-2 seconds and may briefly followed by periods of confusion

• ”spacing out” or vacant eyes for several seconds at a time which may be briefly followed by periods of confusion 

• no or minimal progression towards developmental skills

6-9 months old 

• everything above and 

• has not developed consistent head and neck control by 6 months old 

• not reaching by 6 months old

• not sitting by 9 months old 

• no efforts/progression toward independent mobility (not attempting to roll, scoot, pivot in prone, belly crawl, etc) 

9-12 months old

• everything above

• no independent mobility (not rolling, scooting, belly crawling, army crawling, etc)

If you are checking off several items on the lists provided above, it’s time to call your pediatrician and request a neurological screen, referral to Nevada Early Intervention Services, and potentially a referral to other medical specialists. Please do not hesitate to reach out to me as well! You are still eligible to receive mobile or outpatient pediatric physical therapy services in Northern Nevada even while utilizing Nevada Early Intervention Services.

As a pediatric physical therapist, I am trained to identify potential delays as early as possible. Early detection strategies have come a long way and can even identify cerebral palsy as early as 5 months of age per the American Academy for Cerebral Palsy and Developmental Medicine. Even infants younger than 5 months of age, are able to have their risk level assessed and monitored. Early implementation of therapies is ideal as it allows for the greatest chance for neuroplasticity. 

In Part 2, I will discuss the current standardized assessments and data for early therapies. 

If you have finished reading this article and feel a deep pit in your stomach and are worried about your child’s development, please know that your child is still perfect and loved. Regardless of diagnoses or lack thereof, delayed development is a complex journey. There are many local organizations in Reno-Sparks that provide support to parents and help guide you through the storm. In Northern Nevada these organizations include the Special Needs CommUNITY of Northern Nevada, the Canopy Collective, Nevada PEP, the Family Navigation Network, United Cerebral Palsy of Nevada, and many more. You are not alone! 

I sincerely hope the best for you and your child. Please don’t be afraid to reach out for anything – reassurance, guidance, or validation.